Individual
CYNTHIA R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.M.
Contact information
Practice address
2060 DAN PROCTOR DR, SUITE 1200, SAINT MARYS, GA 31558-3894
(912) 540-6750
(912) 540-6773
Mailing address
2060 DAN PROCTOR DR, SUITE 1200, SAINT MARYS, GA 31558-3894
(912) 540-6750
(912) 540-6773
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
RN046062
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00668885A
—
GA
Enumeration date
10/18/2007
Last updated
02/12/2015
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